A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.

Check the client's current fingerstick blood glucose.

Obtain blood pressure and heart rate.

Administer a PRN dose of regular insulin.

Give the client 4 ounces (120 mL) of orange juice.

Provide the client with 1/2 cup (120 mL) diet carbonated soda.

Answer and Explanation

Correct Answer : A,D

Choice A reason: Checking the client's current fingerstick blood glucose is important to determine if the confusion and weakness are due to hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Choice B reason: Obtaining blood pressure and heart rate is useful for a general assessment but is secondary to assessing blood glucose levels in this scenario.

Choice C reason: Administering a PRN dose of regular insulin is not appropriate without first determining the client's blood glucose level. If the client is hypoglycemic, insulin could worsen the condition.

Choice D reason: Giving the client 4 ounces (120 mL) of orange juice is a quick way to raise blood sugar levels if the client is hypoglycemic.

Choice E reason: Providing diet carbonated soda is not effective for treating hypoglycemia because it does not contain sugar to raise blood glucose levels.

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Correct Answer is ["A","C","D","E"]

Explanation

Choice A reason: EMR tracking systems monitor and alert for unauthorized access attempts, ensuring compliance with privacy regulations.

Choice B reason: While encouraging the friend to discuss concerns is good advice, it is not directly related to the legal and ethical aspects of accessing the EMR.

Choice C reason: EMR safeguards ensure that only authorized personnel involved in direct care can access a client's medical records.

Choice D reason: Obtaining the client's permission is a prerequisite for sharing medical information, ensuring respect for client privacy and autonomy.

Choice E reason: Reviewing the EMR without proper authorization violates client confidentiality and is both legally and ethically prohibited.

A. Don an N95 respirator mask, face shield, gown, gloves, and shoe coverings prior to returning to the room. B. Explain to the client to inform others that they may have been potentially exposed in the last 14 days. C. Teach the client to wear a mask, hand wash, and social distance to prevent spreading the virus. D. Notify the charge nurse the client will need assignment to the COVID-19 specified area of the facility.

Correct Answer is A

Explanation

Choice A reason: Donning appropriate personal protective equipment (PPE) is the most important action to protect the healthcare provider and prevent the spread of the virus while caring for the client.

Choice B reason: Explaining to the client to inform others about potential exposure is important but can be done after ensuring the nurse's safety with proper PPE.

Choice C reason: Teaching the client to wear a mask, hand wash, and social distance is important for preventing the spread of the virus but is not the immediate priority.

Choice D reason: Notifying the charge nurse about the need for assignment to a COVID-19 specified area is necessary for infection control but follows the immediate action of donning PPE.

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A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.

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Naxlex Comprehensive Predictor Exams

The friend of a nurse who works in an acute care hospital asks the nurse to review the adult daughter's electronic medical record (EMR) to determine if she is honestly disclosing her medical condition. The nurse's reply should include which information? Select all that apply.

Correct Answer is ["A","C","D","E"]

Explanation

The nurse is preparing to obtain a rapid coronavirus (COVID-19) test for a client who was exposed to the virus eight days ago. The client is experiencing fever, cough, and shortness of breath. Which action is most important for the nurse to take?

Correct Answer is A

Explanation

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